Pharmacists play key role in HIV prevention care

Canadian HIV experts, including pharmacist Jaris Swidrovich, release new guidelines for HIV prevention medication on World AIDS Day

In recent years, new drugs to treat HIV have been approved in Canada, making it a manageable chronic condition. But HIV remains a significant public health concern: The most recent data from the Public Health Agency of Canada shows that more than 2,400 people in Canada were diagnosed with HIV in 2023, a 35 per cent increase from the previous year – despite the availability of highly effective HIV prevention medications.

A multidisciplinary team – including Jaris Swidrovich, assistant professor at the Leslie Dan Faculty of Pharmacy and a certified HIV pharmacist – recently updated guidelines about the use of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to prevent HIV infection. The updated guidelines were published today in the Canadian Medical Association Journal (CMAJ).

“HIV is such a complicated disease that still has so much stigma associated with it. And prevention of HIV is no exception,” says Swidrovich, who contributed to the guidelines and is leading the writing of the companion publication for pharmacists. “Certain peoples, groups, and other intersectional identities are far overrepresented in this space, partly because we as health care providers haven't done a great job working with them to ensure they are aware of the prevention options and have access to them.”

PrEP is an antiretroviral medication taken on an ongoing basis to prevent HIV infection. PEP is an oral antiretroviral medication taken for about a month after a known or potential exposure. Both are highly effective in preventing HIV infection.

For several years, PrEP has only been available as a daily oral medication, but within the last year, a new formulation that is injected every two months was approved in Canada.

The last Canadian guidelines for HIV PrEP and PEP use were published in 2017, and significant advances – specifically these new PrEP formulations and a growing body of evidence in specific populations including pregnant people, Indigenous Peoples, 2SLGTBQ+ peoples, and adolescents – necessitated an update.

“The HIV field is so rapidly moving. New drugs and dosages for PEP and PrEP have revolutionized HIV treatment and prevention, and we know more now about how we can tailor our prevention strategies toward certain groups,” says Swidrovich.

Dr. Darrell Tan, an infectious disease specialist at St. Michael’s Hospital, led the guideline development, which took place through the Canadian Institutes of Health Research (CIHR) Pan-Canadian Network for HIV and STBBI Clinical Trials Research and with input from targeted community organizations.

The multidisciplinary group – which included physicians, nurses, pharmacists, social workers, and people with lived experience – reviewed the available evidence and made 31 recommendations and 10 good practice statements for the use of PrEP and PEP, covering indications for use, specific regimens, and clinical considerations for different groups and circumstances. The guidelines assist health care providers with ensuring that people who want or need PrEP or PEP are able to access it.

Swidrovich says that HIV medications often have significant drug interactions, and it’s important for pharmacists to be actively involved in HIV care to help prevent any potential interactions with patients’ other medications.

And, adds Swidrovich, pharmacists also play critical roles in destigmatizing HIV care and helping patients understand and access the prevention medications they need.

“Pharmacists are one of the most accessible, trusted health care professionals, and patients typically see pharmacists far more often than they see other primary care providers.”

“Pharmacists are one of the most accessible, trusted health care professionals, and patients typically see pharmacists far more often than they see other primary care providers,” says Swidrovich.

“Pharmacists can do more than ensure that people know how to take their medications and reduce their risk of HIV infection. Our presence and level of trust and accessibility are so important in destigmatizing HIV care and promoting prevention education.”